Ketamine in Modern Neuroanesthesia Practice
AbstractPurpose of ReviewKetamine has a number of clinical uses and properties that suggest a role for the drug in neuroanestheisa practice. “Dogma” and “myths” persist with regard to its effects on cerebral hemodynamics and intracranial pressure which have limited its use in Neuroanesthesia and care of the critically ill brain-injured patient. This review aims to educate the clinician on the possible role of ketamine in modern n euroanesthesia practice.Recent FindingsA number of systemic reviews support the use of ketamine in patients with acute brain injury and raised intracranial pressure (ICP). Pre-clinical wor...
Source: Current Anesthesiology Reports - July 19, 2021 Category: Anesthesiology Source Type: research
“Pick Up a Knife, Save a Life”: Emergency Front-of-Neck Airway for the Non-Surgeon Clinician
AbstractPurpose of ReviewProficiency obtaining an emergency front-of-neck airway (eFONA) is a requirement of all advanced airway managers. The aim of this review is to discuss a single, ideal eFONA technique for non-surgeon clinicians faced with “can’t ventilate, can’t oxygenate” (CVCO) scenarios. We intend to identify potential pitfalls of the suggested technique and to provide practical strategies to optimize procedure success in crisis.Recent FindingsIdentification of the cricothyroid membrane via solely external palpation has been shown to be unreliable, particularly in the obese and in females irrespective of ...
Source: Current Anesthesiology Reports - July 17, 2021 Category: Anesthesiology Source Type: research
Obesity, Race, and Perioperative Complications
AbstractPurpose of ReviewThis review highlights the perioperative issues pediatric anesthesiologists may encounter while caring for an increasingly obese and racially/ethnically diverse patient population. We provide insight into the scope and impact of both pediatric obesity and pediatric minority status on perioperative management and outcomes and emphasize their points of intersection.Recent FindingsIn recent decades, obesity prevalence in children has steadily increased and the age at onset has declined. Obesity confers significant perioperative risk in pediatric patients and has strong associations with additional com...
Source: Current Anesthesiology Reports - July 17, 2021 Category: Anesthesiology Source Type: research
The Anesthetic Management of Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery
AbstractPurpose of ReviewThis review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery.Recent FindingsMost thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated video-assisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in ...
Source: Current Anesthesiology Reports - July 16, 2021 Category: Anesthesiology Source Type: research
State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients
AbstractPurpose of ReviewThis review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology ’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics.Recent FindingsResearchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of...
Source: Current Anesthesiology Reports - July 14, 2021 Category: Anesthesiology Source Type: research
Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic
AbstractPurpose of ReviewThis review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures.Recent FindingsA significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating p...
Source: Current Anesthesiology Reports - July 13, 2021 Category: Anesthesiology Source Type: research
Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: a Narrative Review
AbstractPurpose of the ReviewThe present review addresses clinicians and gives an overview about the experimental rationale for pharmacological conditioning associated with volatile anesthetics, opioids, and propofol; the current clinical data; and the technical considerations regarding the clinical routine in cardiac anesthesia.Recent FindingsVolatile anesthetics have been standard of care for general anesthesia for cardiac surgery, especially while using cardiopulmonary bypass. The 2019 published MYRIAD trial was not able to show a difference in mortality or cardiac biomarkers for volatile anesthetics compared to total i...
Source: Current Anesthesiology Reports - July 10, 2021 Category: Anesthesiology Source Type: research
Hypoxemia During One-Lung Ventilation: Does It Really Matter?
AbstractPurpose of ReviewHypoxemia during one-lung ventilation, while decreasing in frequency, persists as an intraoperative challenge for anesthesiologists. Discerning when desaturation and resultant hypoxemia correlates to tissue hypoxia is challenging in the perioperative setting and requires a thorough understanding of the physiology of oxygen delivery and tissue utilization.Recent FindingsOxygen delivery is not directly correlated with peripheral oxygen saturation in patients undergoing one-lung ventilation, emphasizing the importance of hemoglobin concentration and cardiac output in avoiding tissue hypoxia. While hea...
Source: Current Anesthesiology Reports - July 7, 2021 Category: Anesthesiology Source Type: research
Electroencephalogram Monitoring in Anesthesia Practice
AbstractPurpose of ReviewWe review the basic neurophysiological foundations of the adult electroencephalographic signal and how to apply the EEG to the modern anesthetic clinical practice, the different anesthetic drugs signatures, and their neurobiological background. We finally discuss how the intraoperative use of the EEG may be implemented eventually to improve short- and long-term outcomes.Recent FindingsWith the growing knowledge of the electroencephalographic signatures of anesthetic drugs, perioperative EEG monitoring constitutes an important tool to titrate the dose of hypnotic drugs avoiding over- and underdosing...
Source: Current Anesthesiology Reports - July 5, 2021 Category: Anesthesiology Source Type: research
Anesthetic Considerations and Complications of Cleft Palate Repairs. What ’s New?
AbstractPurpose of ReviewThis review illustrates the latest considerations and complications of cleft palate (CP) repair. Cleft lip and palate are the most common craniofacial deformities; their repair is a routine surgery performed early in life. Potential complications might be of severe complexity, and the anesthesiologist must be familiar with them.Recent FindingsThe awareness of neurotoxicity related to anesthesia has grown. Currently, there is no evidence supporting the postponement of CP surgery; early repair is important to ensure the best development of the child. From the pain point of view, the use of dexmedetom...
Source: Current Anesthesiology Reports - July 1, 2021 Category: Anesthesiology Source Type: research
Trauma-Induced Coagulopathy: Diagnosis and Management in 2020
AbstractPurpose of ReviewThis review describes the mechanisms underlying trauma-induced coagulopathy (TIC) and the current strategies to measure and mitigate the negative effects of TIC during the initial stages of trauma resuscitation and care.Recent FindingsTrauma patients can manifest both early hypocoagulable and later hypercoagulable phenotypes. These are not fixed states and patient transition between states postinjury. Recent trends in resuscitation, driven by the military experience, have promoted the return to whole blood as the initial resuscitative fluid in the severely injured patient, but goal-directed blood p...
Source: Current Anesthesiology Reports - July 1, 2021 Category: Anesthesiology Source Type: research
Enhanced Recovery After Cardiac Surgery: Where Do We Stand?
AbstractPurpose of ReviewEnhanced recovery after surgery (ERAS) protocols are multimodal and multi-professional strategies to enhance postoperative convalescence and thereby reduce the length of hospital stay and hospital-associated complications. This review provides an up-to-date overview about basic principles of enhanced recovery after surgery protocols, their transfer into cardiac surgery, and their current state of evidence. It is supposed to offer clinical implications for further adaptations and implementations of such protocols in cardiac surgery.Recent FindingsERAS protocols are a story of success in numerous sur...
Source: Current Anesthesiology Reports - June 29, 2021 Category: Anesthesiology Source Type: research
Ultrasound Imaging of the Spine for Central Neuraxial Blockade: a Technical Description and Evidence Update
This article describes the anatomy of the spine, relevant ultrasonographic views, and the techniques used to perform the neuraxial blocks using ultrasound imaging. Finally, we review the available evidence for the use of ultrasound imaging to perform neuraxial blocks.Recent FindingsCentral neuraxial blockade using traditional landmark palpation is a reliable technique to provide surgical anesthesia and postoperative analgesia. However, factors like obesity, spinal deformity, and previous spine surgery can make the procedure challenging. The use of ultrasound imaging has been shown to assist in these scenarios.SummaryPrepro...
Source: Current Anesthesiology Reports - June 26, 2021 Category: Anesthesiology Source Type: research
Anesthesia Considerations for Transcatheter Mitral and Aortic Valve Procedures
AbstractPurpose of ReviewThis review considers the anesthetic management for patients undergoing transcatheter mitral valve replacement and repair (TMVR and TMVRep) and transcatheter aortic valve replacement (TAVR). Clinical indications and preoperative considerations will be discussed before exploring intraoperative anesthetic management and potential complications. To conclude, the echocardiographic assessment for each procedure will be reviewed.Recent FindingsAdvancements in transcatheter techniques have made it a viable option for patients who are poor surgical candidates. As a result, anesthetic management, including ...
Source: Current Anesthesiology Reports - June 17, 2021 Category: Anesthesiology Source Type: research
Postoperative Delirium
AbstractPurpose of ReviewThis review is aimed to provide an up-to-date summary of the diagnosis, risk factors, and management of postoperative delirium (POD) with a focus on latest evidence-based clinical studies.Recent FindingsThere is strong association between POD and long-term cognitive decline. Among the various alternatives, Confusion Assessment Method (CAM) remains the most common screening tool for POD diagnosis. Preoperative anemia and hyperglycemia are additional independent risk factors of POD. Multicomponent non-pharmacological interventions are effective in decreasing the occurrence of POD. Dexmedetomidine and...
Source: Current Anesthesiology Reports - May 8, 2021 Category: Anesthesiology Source Type: research
